Socioeconomic value of treatments for chronic idiopathic constipation in Japan.

BACKGROUND

Chronic idiopathic constipation (CIC) is a common disorder associated with socioeconomic burden. The aim of this study was to quantify the socioeconomic burden of CIC, including non-traditional value elements, and to compare the cost-effectiveness of 3 treatments for CIC with unique mechanisms of action: elobixibat 10 mg, linaclotide 0.5 mg, and lubiprostone 48 μg.

METHODS

We compared medical costs and CIC-specific quality of life (QoL) among patients treated with elobixibat 10 mg, linaclotide 0.5 mg, and lubiprostone 48 μg using a Markov cohort simulation model of 4 mutually exclusive health states (CIC, unimproved, improved, and death) with 4-week cycles and a 2-year time horizon. In addition to costs and QoL scores, which were discounted at 2.0% per year, we considered productivity loss and caregiver burden for patients requiring assistance with daily living and defecation management.

RESULTS

Patients treated with elobixibat 10 mg showed lower total costs and better QoL than those treated with linaclotide 0.5 mg (+ 76,241 Japanese yen [JPY], QoL + 0.034) and lubiprostone 48 μg (JPY + 62,050, QoL + 0.014). The deterministic sensitivity analysis showed that the base-case results were generally robust to changes in most input parameters but were sensitive to the effectiveness of elobixibat and lubiprostone; effectiveness of - 20% for elobixibat and + 20% for lubiprostone resulted in higher costs and poorer QoL for elobixibat 10 mg than lubiprostone 48 μg. The probabilistic sensitivity analysis showed that approximately 72.3% and 64.0% of observations showed better QoL for elobixibat 10 mg than linaclotide 0.5 mg and lubiprostone 48 μg, respectively. Scenario analyses in which no discounting was applied and higher mortality for unimproved patients was assumed yielded similar results to the base-case analysis.

CONCLUSIONS

Considering CIC-related medical costs, QoL, productivity loss, and caregiver burden, elobixibat 10 mg is associated with better QoL and lower costs than linaclotide 0.5 mg and lubiprostone 48 μg.

TRIAL REGISTRATION: This trial was registered with the UMIN Clinical Trials Registry, registration number UMIN000055903 (registration date: 21 October 2024).